Zhu Lisa Yujia, Larsen Janne Tidselbak, Nissen Judith Becker, Crowley James J, Mattheisen Manuel, Bulik Cynthia M, Petersen Liselotte Vogdrup, Yilmaz Zeynep
Department of Psychology, University of Western Ontario, London, Ontario, Canada.
National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
Int J Eat Disord. 2025 Sep;58(9):1817-1829. doi: 10.1002/eat.24486. Epub 2025 Jun 17.
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are highly comorbid; however, limited research has examined etiological pathways specific to individuals with AN developing OCD or individuals with OCD developing AN. This exploratory study aimed to identify factors influencing AN-OCD comorbidity with a focus on the order of diagnosis.
Using Danish national registers, 6449 individuals with AN and 9352 individuals with OCD were examined to assess the risk of subsequent OCD and AN. Explored predictors included parental characteristics, birth characteristics, childhood adversity, autoimmune and autoinflammatory diseases, psychiatric disorders, and prescriptions. Hazard ratios (HR) were calculated using Cox regression. Parallel analyses were conducted for the risk of subsequent anxiety disorder to determine predictors unique to AN-OCD comorbidity.
Among individuals with AN, high birth weight (HR = 3.06) was uniquely associated with increased risk of subsequent OCD. For individuals with OCD, a history of other eating disorders (HR = 7.47) was associated with elevated risk of developing AN, whereas anxiety disorders in first-degree (HR = 0.32) and female first-degree relatives (HR = 0.22) were uniquely protective against AN.
These exploratory findings suggest that distinct pathways may be involved in the order of onset for AN-OCD comorbidity. Specifically, for individuals with AN who subsequently developed OCD, high birth weight appeared to increase risk, whereas for individuals with OCD who later developed AN, familial anxiety disorders seemed to play a protective role. Findings could inform early screening and prevention efforts for individuals with AN at high risk for OCD, and vice versa.
神经性厌食症（AN）与强迫症（OCD）高度共病；然而，针对AN患者发展为OCD或OCD患者发展为AN的个体特异性病因途径的研究有限。这项探索性研究旨在确定影响AN - OCD共病的因素，重点关注诊断顺序。
利用丹麦国家登记册，对6449名AN患者和9352名OCD患者进行检查，以评估后续发生OCD和AN的风险。探索的预测因素包括父母特征、出生特征、童年逆境、自身免疫和自身炎症性疾病、精神障碍及处方。使用Cox回归计算风险比（HR）。对后续焦虑症风险进行平行分析，以确定AN - OCD共病特有的预测因素。
在AN患者中，高出生体重（HR = 3.06）与后续发生OCD的风险增加具有独特关联。对于OCD患者，其他饮食失调史（HR = 7.47）与发展为AN的风险升高相关，而一级亲属（HR = 0.32）和女性一级亲属的焦虑症（HR = 0.22）对AN具有独特的保护作用。
这些探索性研究结果表明，AN - OCD共病的发病顺序可能涉及不同途径。具体而言，对于随后发展为OCD的AN患者，高出生体重似乎会增加风险，而对于后来发展为AN的OCD患者，家族性焦虑症似乎起到保护作用。研究结果可为OCD高风险的AN患者以及反之亦然的早期筛查和预防工作提供参考。
